Huck Holz

Bilateral diffuse lamellar keratitis following consecutive selective laser trabeculoplasty in LASIK patient

A 48-year-old man with a history of myopic laser in situ keratomileusis (LASIK) had selective laser trabeculoplasty (SLT) for the treatment of glaucoma in the right eye. He subsequently developed grade 2 diffuse lamellar keratitis (DLK). He then elected to have SLT in the left eye and developed grade 1 DLK. To our knowledge, this is the first report of bilateral consecutive late postoperative DLK following SLT after LASIK.

Surgical management of pediatric limbal dermoids with sutureless amniotic membrane transplantation and augmentation.

PURPOSE To further evaluate the efficacy of a new surgical technique for removal of pediatric corneal-limbal dermoids and ocular surface reconstruction using multilayered amniotic membrane. METHODS Three pediatric patients with corneal-limbal dermoid (grade I) in one practice were identified in a retrospective fashion. All patients underwent deep lamellar excision followed by sutureless multilayered amniotic membrane transplantation by a single surgeon (AP). Preoperative and postoperative visual acuity, anterior segment examination, anterior segment B-scan, and cycloplegic refraction were performed. RESULTS Three patients with ages ranging from 6 months to 18 years had a postoperative follow-up of 9 to 12 months from the time of surgery. This surgical technique achieved rapid postoperative corneal re-epithelialization, reduced postoperative pain, and diminished postoperative scarring in all three patients. Existing preoperative astigmatism remained unchanged throughout the follow-up period. No intraoperative or postoperative complications were noted. CONCLUSION This surgical approach offers an alternative surgical technique to a simple excision with or without deep lamellar keratoplasty for removal of pediatric corneal-limbal dermoids (grade I). In the management of pediatric limbal dermoids (grade I), surgical excision combined with sutureless multilayered amniotic membrane transplantation eliminates painful postoperative recovery and corneal neovascularization, and can achieve an improved long-term ocular surface cosmesis.

Complications of NewColorIris implantation in phakic eyes: a review

Purpose: To provide a literature review of implant related complications from bilateral NewColorIris implantation (Kahn Medical Devices, Panama City, Panama). Methods: A PubMed search of peer-reviewed ophthalmology journals for complications related to NewColorIris implants was performed. Results: Including a recent case published by the authors, a total of nine patients (18 eyes) with management of complications such as endothelial cell loss, elevated intraocular pressure (IOP), corneal edema, anterior chamber inflammation, decreased visual acuity, and cataract formation were reviewed. Conclusions: Sight-threatening complications including corneal decompensation, IOP elevation, uveitis, and hyphema have been described after NewColorIris implantation.

Fibrin-glue assisted multilayered amniotic membrane transplantation in surgical management of pediatric corneal limbal dermoid: a novel approach

PurposeTo report a new surgical technique for excising pediatric corneal limbal dermoid and the post-resection ocular surface reconstruction.MethodsWe describe a method of deep lamellar excision followed by sutureless multilayered amniotic membrane transplantation in surgical management of corneal limbal dermoid.ResultThis technique achieves a rapid corneal re-epithelization, reduces post-operative pain, and will diminish post-operative scarring. Preoperative corneal astigmatism will persist.ConclusionThis method offers an alternative surgical approach in comparison to simple excision in removal of simple pediatric corneal limbal dermoids.

Acquired infantile Horner syndrome and spontaneous internal carotid artery dissection: A case report and review of literature

Horner syndrome, a triad of ptosis, anisocoria, and anhidrosis, results from interruption in the oculosympathetic pathway. It is classically described as either congenital or acquired to depict its underlying pathophysiology and requisite work-up. We report a case of a 10-month-old infant presenting with an acute onset of left Horner syndrome secondary to a spontaneous extracranial internal carotid artery dissection. To the best of our knowledge, this is the first case report in the literature of acute onset of acquired infantile Horner syndrome in association with spontaneous carotid artery dissection confirmed with magnetic resonance angiogram.

Simultaneous Interface Candida Keratitis in 2 Hosts Following Descemet Stripping Endothelial Keratoplasty With Tissue Harvested From a Single Contaminated Donor and Review of Clinical Literature.

PurposeThe objective of this study was to report 2 cases of interface fungal keratitis in 2 separate patients following Descemet stripping automated endothelial keratoplasty (DSAEK) with tissue harvested from the same donor. DesignThis was a retrospective simultaneous interinstitutional hosptial-based case reports. MethodsTwo patients with corneal infections following DSAEK were identified from 2 individual practices. Both patients had undergone DSAEK from the same donor. Preoperative and postoperative eye examination included visual acuity, anterior and posterior segment evaluations, and clinical follow-up course from the time of surgery. Methods of medical therapy and surgical intervention are additionally discussed. ResultsThe 2 patients presented in our series present with interface fungal keratitis postoperatively in the face of the original source coming from a single donor (patient 1: 7 days postoperatively and patient 2: 7 weeks postoperatively). As medical treatment failed in both cases, surgery was undertaken in both cases (therapeutic penetrating keratoplasty). With prompt recognition as well as medical and surgical treatment, patient 1 achieved best corrected visual acuity of 20/30 at 6 months postoperatively, and patient 2 had best corrected visual acuity of 20/80 at 10 months postoperatively. ConclusionsFungal keratitis following DSAEK occurs in a sequestered space and therefore represents a treatment challenge with potentially devastating outcome. We recommend an aggressive surgical approach with early removal of the donor button and irrigation with intracameral antifungal agents.

Management of corneal endothelial decompensation caused by iris-fixated phakic intraocular lenses with descemet stripping automated endothelial keratoplasty.

Purpose: To describe 2 cases of corneal decompensation after iris-fixated phakic intraocular lens (pIOL) implantation requiring Descemet stripping automated endothelial keratoplasty (DSAEK). Materials and Methods: Case reports and literature review. Results: Two cases of corneal decompensation after pIOL implantation are reported. The average age at presentation was 52 years (range: 37 to 67 years) in 2 women. The mean presentation time of corneal decompensation after pIOL implantation was 29 months (range: 22 to 36 months). Both the affected eyes required pIOL explantation and DSAEK to treat corneal decompensation. One patient (1 eye) had concurrent cataract surgery to maximize visual rehabilitation. The mean follow-up after DSAEK surgery was 14 months (range: 12 to 16 months). The best-corrected visual acuity was 20/50 (range: 20/40 to 20/60) at the last follow-up. Conclusions: Despite a good safety profile for iris-fixated pIOLs, some patients may still develop corneal decompensation after implantation. We report a pair of cases with corneal decompensation severe enough to warrant endothelial transplantation and pIOL explantation, with and without concomitant cataract surgery.

Iris mattress suture: a technique for sectoral iris defect repair

Achieving a cosmetic and functional outcome from iris defect repair is a surgical challenge. We describe an adaptation of techniques to address a case of 2.5 clock hours of sectoral iris tissue defect. Our method combines Siepsers modified closed-chamber sliding knot technique with the placement of a double-armed iris mattress suture to approximate iris tissue to the scleral wall and thereby create a pseudo-iris root. This technique reduces glare and achieves a cosmetic outcome for the patient.